MEDICARE: DR. TODD MICHAEL TRIMBOLI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2951	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396821526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD MICHAEL TRIMBOLI DDS

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:	4751 RT 152
City	:	LAVALETTE
State	:	WV
Zip	:	25535-0158
Country	:	US
Telephone Number	:	304-529-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 RT 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-0158
Country	:	US
Telephone Number	:	304-529-2036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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